Differences in the function of the prefrontal cortex between women with urge urinary incontinence and continent cohorts

Purpose. The purpose of this study was to determine if women with good control of bladder function (continent) would perform better than women expressing symptoms of urge urinary incontinence (UUI) on behavioral tasks that depend on cognitive processes in the prefrontal cortex (PFC). UUI is involuntary urine loss preceded by a sudden sensation of impending urination, and people with this disorder urinate more than 8 times in a 24-hour period. Control of bladder function (storage and elimination of urine) is a voluntary behavior that relies on processes in the prefrontal cortex of the brain to generate a "conscious" control mechanism; and women with UUI may not have sufficient working memory capacity to control bladder function. Since there are few effective interventions available for UUI, the goal of nursing is to develop new knowledge as a basis for interventions from a behavioral-cognitive perspective.; Materials and methods. This exploratory study used a battery of tests to measure cognitive processes in the prefrontal cortex on behavioral performance, and measures to determine bladder perception for a first desire to void (FDV) and a strong desire to void (SDV) and urine volume in the bladder at these sensory points. The sample consisted of twenty continent women and twenty women with symptoms suggesting UUI, ages 60 to 79 years.; Results. The most significant findings were that incontinent women demonstrated poorer working memory capacity (WMC) and had slower speed of cognitive processing compared to continent cohorts. Continent subjects in the upper quartile of the distribution for WMC perceived a FDV at higher urine volumes (approaching significance) compare to incontinent cohorts. Comparisons of incontinent to continent women showed no differences in bladder perception for a FDV, SDV, or for urine volumes at a SDV.; Conclusions. This is the first study to reveal functional differences in the prefrontal cortex of women with UUI compared to continent cohorts. Findings imply that a high level of WMC performance allows continent women to control bladder function and store a higher volume of urine in their bladder (until circumstances are appropriate for bladder emptying) compared to incontinent women. Thus we speculate that cognitive interventions may be helpful for people with UUI.